The jokes and quips like, ‘does my bum look big in this?’ and the length of time it takes to get ready for a night out are often rooted in light-hearted fun. However, for approximately 3% of people, how they feel about their looks, body and image can have severe implications on life, home, work and relationships.
Over-Evaluation of Shape and Weight in Eating Disorders
Those who meet the criteria for a diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder or body dysmorphic disorder appear to experience and notice feeling fat more intensely.
The same group associates this feeling with higher levels of distress over more extended periods. This can lead to compensatory behaviours, including restricting calorie intake, over-exercising, vomiting or purging, laxative abuse, obsessive thoughts and behaviours, self-harm and ultimately, thoughts or actions linked to suicide.
Let’s look at why we feel fat and why this feeling is closely linked to disordered eating and body image concerns for teenagers, young adults and the families who love them.
Physical or Biological Change
Feeling fat can be a potent feeling. However, we know that the body does not change in this way – daily or even hourly changes to shape, size, and fat distribution are just not possible.
We mislabel fat. So, what is really happening when we feel fat?
If the fat that we ‘feel’ is not a ‘feeling’, we may be attempting to describe a state or sensation that has a particular and descriptive meaning for us. Research indicates that people, specifically people with food and body issues, equate feeling fat with feeling bad. In turn, we reinforce that being thinner equates to being healthier and happier. It is, however, the bad feeling that we attempt to describe in all of its complexity. Our feeling fat is a shorthand internal rule or message for many more subtle events and changes.
There are three reasons why we may feel fat:
1. We Have Increased Bodily Awareness
Something may have caught our attention and made us more aware of our bodies. For those meeting the criteria for diagnosis of an eating disorder and body dysmorphic disorder, there is a heightened awareness or high alert state for much of the time.
Factors that may increase our bodily awareness include:
- Someone commenting on our appearance (in either a positive or negative manner)
- Feeling sweaty
- Feeling movement or wobbles during exercise
- Clothing that feels tight or unusual against the skin
- Body checking
- Bloating
- Feeling unwell
2. We Experience an Uncomfortable or Adverse Physical State
We may mislabel or misfile other uncomfortable, unpleasant or adverse physical states. The experience of these may trigger us to label ourselves negatively or critically.
Examples of adverse physical experiences include:
- Bloating
- PMS (premenstrual syndrome)
- Feeling excessively full
- Feeling sleepy, tired or exhausted
- Feeling bloated, puffy or sore
3. We May be Experiencing Other Emotions
We may mislabel emotions that we find uncomfortable, unpleasant or exhausting. These emotions may be difficult to place, and we associate them with a negative bodily experience.
Some examples of negative emotional states and experiences that may make us feel fat include:
- Feeling low
- Feeling bored
- Feeling lonely
- Feeling unloved
Body Dysmorphic Disorder
Feeling fat can be a symptom of body dysmorphic disorder. Body dysmorphic disorder (BDD) is a complex diagnosis, leading sufferers to experience obsessive thoughts and behaviours related to their body and appearance. The thoughts control the person to the extent that they can think or feel little else, often making extensive plans and going to extreme lengths to change their perceived imperfections.
BDD affects men and women equally and can often begin in adolescence or early adulthood, although later onset is not uncommon. BDD can coexist with substance use disorders, eating disorders or other drug and alcohol issues. Those affected describe using substances or behaviours to distract from the emotional pain and distress of life with BDD.
It is very usual for those experiencing BDD to focus on flaws or issues that are not obvious or only noticeable under scrutiny. In the view of the BDD sufferer, the flaws will be so extreme that they will go to any lengths to change, remove or disguise parts of themselves that they will describe as disgusting. Ritualistic behaviours, isolation and avoiding situations are common as the symptoms progress.
Clothing, cosmetics and surgery that camouflage the disliked areas are utilised, and rituals can become part of long routines to minimise the exposure of the flaws. Disruption to this routine or additional problems (acne breakouts, hair problems, rashes or injury) can cause further depression, anxiety, anger and often rage. The internal rage may promote incidents of self-harm, leading to shame, guilt and other unpleasant experiences.
Health at Every Size (HAES)
As parents, carers, educators and mental health professionals, we can promote nurturing acceptance in our young people. This is directly at odds with the body-punishing messaging that can be found in the media.
Our bodies are not all the same. Just as your shoe size and foot shape are slightly different from those around you, so is every part of your body. To attempt to shoehorn your foot into a much smaller shoe would be rather painful, and it is precisely the same principle with our bodies.
Each person’s genetic make-up is unique, and this make-up influences our bone structure, shape and weight. We can work together to appreciate those differences, and we can nurture and love our bodies whilst being mindful of the exceptional jobs they do.
Ideal weight is not a number on a scale or a colour on a BMI grid. It can be numerous weights, shapes, looks and sizes. Well-being and a body that is loved and appreciated is empowering.
Finding connection and fulfilling your emotional, physical and psychological needs helps place food in a neutral space. Accepting food as nourishment and pleasure will support your body in finding a content space whilst honouring hunger, fullness and appetite.
Conclusion
Treatment for body dysmorphia often requires inpatient or residential care, with assistance from a psychiatrist and mental health team. The Wave Clinic advises that clients with BDD or families who recognise obsessive behaviours similar to those described above consult a mental health professional.
Exposure therapy, CBT and motivational interviewing can assist patients in reality-checking and confronting black and white thinking styles. With the guidance of a good therapist who has extensive experience in treating BDD, remission is possible, and long term recovery is achievable in many cases. If you or someone you love has identified with any of the symptoms described above, contact your GP, a health professional, or The Wave Clinic.
* ’Fat’ is used in this article as a descriptive term, used by young people and adults in consultation and colloquially. There are no pejorative connotations.
Fiona Yassin is the International Clinical Director of The Wave Clinic. Fiona is a UK Registered Adolescent and Family Psychotherapist and Clinical Supervisor (Licence number #361609 NCP/ICP), further trained in the specialty of Eating Disorders and Borderline Personality Disorder Treatment. Fiona is trained in FBT (Family Based Therapy), CBTE for eating disorders, FREED (King’s College, London), EMDR for eating disorders (EMDRIA) and has a Post-Graduate Diploma in Neuroscience and Trauma from the University of Tennessee, Knoxville.
Fiona works with international families and family offices from the UK, Dubai, Kuwait, Singapore and Malaysia. Fiona can be contacted by email on fiona@thewaveclinic.com.
